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• W2331436300 abstract "Vaccinations represent important elements for the prophylaxis of preventable diseases (1). A study from 1997 (2) demonstrated protective antibody titers against diphtheria for only 38% and against tetanus for 90% in children after KTX. The efficacy of immunizations is not as high in immunosuppressed patients compared with healthy individuals, and also, there is frequently loss of antiviral titer in short time (2–4). Information on development of immunization titers in KTX children is scarce in the literature. Data were collected retrospectively from children after KTX from 2005 to 2009 (n=94; 2–18 yr- median, 11). Minimum follow-up was 1 year. The average follow-up was 2.7 years. Thirteen patients had to be excluded because of incomplete data. The immunization dates and titers of tetanus, diphtheria, hepatitis B, and varicella were recorded annually for every patient, as well as renal function parameters and immunosuppressive therapy. eGFR was estimated by Filler equation (5). The whole dataset was used for all analyses. All patients were subdivided into 4 groups. Group A: cyclosporine A or tacrolimus with mycophenolatmofetil, group B: cyclosporine A or tacrolimus, Group C: cyclosporine A or tacrolimus with an mTOR inhibitor, group D: mycophenolate mofetil and cyclosporine A or tacrolimus, group C: mTor-inhibitor alone or in combination with cyclosporine A or tacrolimus. Forty of 81 children received low-dose steroids (2.5–5 mg prednisolone, OD). For statistical analysis, we used IBMSPSS-Statistics 19 (IBM Germany), the R statistical program 2.12.1 (GNU, USA), and Graph Pad Prism 5.01 (Graph Pad Software Inc, USA). In case of normal distribution, means were compared using two-tailed t test, median values using Mann-Whitney U test, and correlation analysis using Spearman test. P<0.05 was defined as significant. After KTX, the children showed sufficient immunization titers for diphtheria (≥0.1 I/mL; median, 0.26) in 75% of measurements, whereas in 69%, sufficient levels for tetanus (≥0.5 IU/mL) were present. Median diphtheria levels were 0.26 IU/mL (range, 0.01 to >2 IU/mL), and median tetanus titer was 0.66 IE/mL (range, 0.04 to >10 IU/mL). Significantly lower titers were found for anti-HBs (Fig. 1C). In only 32% of measurements, the patients had sufficient protection against hepatitis B (titer, >100 IU/L). Values ranged from less than 10 to greater than 1,000 IU/L (median, 48). Varicella titers ranged from less than 10 to greater than 4,000 IU/L (median, 612).FIGURE 1: A, Course of diphtheria titers in the first 3 years after KTX. B, Course of tetanus titers in the first 3 years after KTX; C, Course of hepatitis B titers in the first 3 years after KTX. D, Course of Varicella titers in the first 3 years after KTX.Immunization titers decreased over time without revaccination, depending on the duration of follow-up. This decrease was significant in diphtheria, tetatnus, and hepatits B between years 1 and 2 and 1 and 3 (P=0.001, P=0.017; P<0.0001, P=0.001; P<0.001, P<0.001) but not in Varicella (P>0.05; P>0.05). No correlation was found between GFR and immunization titers for diphtheria, tetanus, and hepatitis B (R2 = 0.0019, 0.0187, 0.0095). Only for varicella titer, a weak statistically significant correlation was found between CKD stage and titers (P=0.05). Comparison of the medians of the immunosuppressive groups did not show any significant differences. Immunization in children after KTX has not been strongly investigated. Only a few recommendations for boosters and immunization regimes have been published. In the present study, we also found gaps in the immunization status with insufficient titers for tetanus, diphtheria, hepatitis B, and varicella. However, a comparatively higher rate of sufficient immunization titers in the children in this cohort might be based on the regular assessments of titers (4). The number of patients with sufficient diphtheria titer fell to 38% after another 12 months (2). Zamora et al. (6) reported 75% to 85% of the kidney-transplanted children having varicella-specific antibodies after a single-dose varicella vaccination 6 to 12 months after immunization. As a result of the dynamic changes found in our analysis with great interindividual differences, we could not determine an exact time point after which a booster vaccination should be given. Therefore, follow-up of regular titer levels are necessary to create an individual immunization schedule. The definition of a protective antibody value in case of varicella is difficult, and the lack of varicella antibodies does not automatically represent the loss of immunologic defense because cell-mediated immunity could be intact (7). In our patients, we observed completely different courses of Varicella titer. We showed that low kidney function was associated with low titers against hepatitis B, and decreasing varicella titers were correlated with increasing CKD stage IV. However, according to low patient numbers, the possibility to generalize our data is limited. It has been shown before that hepatitis B and influenza vaccination were less effective in immunosuppressed patients after KTX (8). In conclusion, there is currently no universally valid immunization schedule for transplanted children. Our results indicate that the procedure should be highly individualized by regular titer assessments. Stefanie Beil Martin Kreuzer Lars Pape Clinic of Pediatric Nephrology Hepatology and Metabolic Diseases Hanover Medical School Hanover, Germany" @default.
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• W2331436300 date "2012-12-15" @default.
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• W2331436300 title "Course of Immunization Titers After Pediatric Kidney Transplantation and Association With Glomerular Filtration Rate and Kidney Function" @default.
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• W2331436300 doi "https://doi.org/10.1097/tp.0b013e3182743d57" @default.
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